Need Care of a Loved One? Fill out the Prospective Client Form below

Want to Join our team? Fill out the Prospective Caregiver Form below

Want to send a Referral to us? Fill out our Referral Form below

Contact Us


Serenity Caring Hands
1911 Grayson Highway Suite 8-164
Grayson, GA 30017

Phone: 678-200-4181

Email: info@serenitycaringhands.com
 

Prospective Client -Needs care of a loved one.

If you are a prospective client who needs care for a loved one please fill the form below and we will contact you for a consultation.

Contact Information

For the person requesting information please provide the following information. (* indicates required information)
First Name*:
  Address *:
  Phone Number *:
Best time to contact*:
Last Name *:
  City/State/ZIP*:
   Email :
         

About your loved one

For the person in need of care please provide the following information:
Relationship


Address* :

City/State/ZIP*:


Current Living Arrangements
   Assistance needed
Please tell us the care needed by selecting all that apply below. You may share additional information in the appropriate area below:

Alzheimer's
Live-in Care
Companionship
Bathing
Dressing
Eating		 Medication Reminders
Meal Prep.
Housekeeping
Laundry
Errands
Toileting
Other

How many hours per day is the care needed?*

  

Rate your loved one's receptiveness

How soon do you need care?*

How did you hear about us?

You may share any other information:

       

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Prospective caregiver - Want to join our team?

We are always expanding. We like to work only with good quality caregivers. If you are a caregiver who can uphold our values and are interested in joining our team please contact us below.

First Name: *
 Street Address : *

Phone Number : *

Best time to contact:*
Last Name :*
City/State/ZIP:*

Email :

   
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Referral Form

Please send a referral to us below

Name of care Recipient:*
Contact Name : *
 Name of referral source: *
Location : *
 Contact Phone Number : *
 How soon is care needed?*
  Contact Email :
 
   
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